Curriculum Vitae

NAME Degree
Date prepared:

Name

Address

Office:

Phone:
FAX:

Home:

Education

Medical School

Postdoctoral Training

Date Speciality Position Institution

1
Licensure and Certification
Date Board/certificate Number

Academic Appointments

Date Academic Title Institution

Hospital Appointments

Date Hospital Title Institution

2
Other Appointments

Date Position Title Institution

Committee Assignments

National

Organization 1 alphabetical
Date Position Title Committee

Organization 2 alphabetical
Date Position Title Committee

Organization 3 alphabetical
Date Position Title Committee

Organization 4 alphabetical
Date Position Title Committee

3
Institutional

Organization 1 alphabetical

Date Position Title Committee

Organization 2 alphabetical
Date Position Title Committee

Medical School Committees

Date Position Title Committee

Departmental Committees

Date Position Title Committee

Memberships
Date Society

Journal Referee Activities

Date Journal Role (editor, adhoc reviewer etc)

4
Awards and Honors

Undergraduate

Date Award Significance (e.g. awarded for top grade in

biology)

Medical School

Date Award Significance (e.g. voted by faculty as top

student in school)

Postgraduate

Date Award Significance (e.g. voted by students best

teacher)

Current Research Interests

Research Funding

Past

Date Grant title, grant agency, grant amount, % FTE, PI/Co PI

Present:

Date Grant title, grant agency, grant amount, % FTE, PI/Co PI

5
Teaching Experience

Undergraduates

Date Course Activity Title Learners Time Frequency?

(hrs)
Eg. e.g. e.g. e.g. annual
RAD502 lecture Dartmouth
undergrads

Preclinical Medical Student Education

Direct teaching activities

Date Course Activity Title Learners Time Frequency?

(hrs)
Eg. e.g. e.g. e.g. annual
RAD502 lecture Dartmouth
undergrads
(6)

Other pre-clinical teaching activities (e.g. course administration, mentoring, Radiology Interest Groups_

Date Activity/Role

Clinical Medical Student Education

Direct teaching activities

Date Course Activity Title Learners Time Frequency?

(hrs)
Eg. e.g. e.g. 3rd year e.g. annual
RAD502 lecture, students (60- e.g. 2 hrs
small group 80)

6
Other clinical teaching activities (e.g. course administration, curriculum design mentoring, Radiology Interest
Groups

Date Student year Activity/Role

Residents and Fellows

Direct teaching activities

Date Course Activity Title Learners Time Frequency?

(hrs)
Eg. e.g. e.g. 3rd year e.g. annual
RAD502 lecture, students (60- e.g. 2 hrs
small group 80)

Other resident/fellow teaching activities (e.g. course administration, curriculum design mentoring,

Date Learner Activity/Role

Post Graduate Students

Direct teaching activities

Date Course Activity Title Learners Time Frequency?

(hrs)
Eg. e.g. e.g. Pharm e.g. annual
RAD502 lecture, PhD students e.g. 2 hrs
small group

7
Other Post graduate teaching activities (e.g. course administration, curriculum design mentoring,

Date Learner Activity/Role

Invited Presentations

Institutional

Date (d/m/yr) Talk title and conference title

Regional

Date (d/m/yr) Talk title and conference title

National

Date (d/m/yr) Talk title and conference title

International

Date (d/m/yr) Talk title and conference title

Scientific/Educational Session Moderation at National Meetings

Date (d/m/yr) Session title and conference title

8
Bibliography

Original Peer Reviewed Articles

1. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

2. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

3. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

Letters to the Editor

1. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

2. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

3. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

Non-Peer Reviewed

1. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

2. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

3. OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

Oral Presentations at National Meetings

1. OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date;
page reference

2. OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date;
page reference

3. OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date;
page reference

Poster Presentation at National Meetings (Peer Reviewed)

9
 1. OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date;
page reference

2. OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date;
page reference

3. OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date;
page reference

Book Chapters

1. OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

2. OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

3. OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

Book Editor

1. OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

Electronic Resources (see Teaching Portfolio for details)

1. Name of resource. Any co’authors. Description of resource. Hyperlinks to resource, MedEdPORTAL or

webpage if available. Date developed.

2. Name of resource. Any co’authors. Description of resource. Hyperlinks to resource, MedEdPORTAL or

webpage if available. Date developed

3. Name of resource. Any co’authors. Description of resource. Hyperlinks to resource, MedEdPORTAL or

webpage if available. Date developed

10